Mode of Transmission

Hepatitis E is excreted in the feces and is transmitted by the fecal-oral route. Transmission is usually by ingestion of contaminated drinking water. Rare cases of person-to-person transmission have been recorded. There is a possibility that transmission by blood transfusion may occur. In the United States where no outbreaks of hepatitis E have been reported, a low prevalence of antibodies to hepatitis E (<2%) in healthy populations is found (5,13).

Some, but not all, studies in sewage workers have shown a higher prevalence of antibodies to hepatitis E when compared to a control population. Studies in swine farmers and swine veterinarians have also shown antibodies to hepatitis E in 10.9% and 23% respectively. There are reports of cases of hepatitis E developing after ingestion of raw deer or wild boar meat, again suggesting a zoonotic infection (14-19).